CERTIFICATE OF INSURANCE (258)
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ,
TII 0510412005
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Eagle Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
10414 N. Dale Mabry Highway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
TamDa FL 33618 INSURERS AFFORDING COVERAGE NAIC#
INSURED Swan Development Advisors, Inc INSURER A; Hartford Fire Insurance Co.
2324 Brandon Rd INSURER B: Houston Casualty Co. ,
INSURER C:
Lakeland FL 33803 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD'l _n~ POLICY NUMBER PO!&Y EFFECllVE POLICY EXPIRATION LIMITS
~NERAL LIABILITY EACH OCCURRENCE S 1.000.000
A x x 21 SBMNV3921 0510212005 05/02/2006 DAMAGE TO RENTED $ 300 000
COMMERCIAL GENERAL LIABILITY
f-- ~ CLAIMS MADE[!] OCCUR MED EXP IAnv one nerson\ $10000
f-- PERSONAL & ADV INJURY $1 000,000
f-- GENERAL AGGREGATE S 2 000.000
n'LAGGREnE LIMIT APflS PER: PRODUCTS - COMP/OP AGG S 2 000.000
POLICY ~R.,: LOC
.M!]"OMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
-'-- ALL OWNED AUTOS BODILY INJURY
(Per person) $
----,- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
(Per accident) $
- NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
RGE LIABILITY AUTO ONLY - EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG $
3ESSlUMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR D CLAIMS MADE AGGREGATE S
S
==1 DEDUCTI~ $
RETENTION $ $
WORKERS COMl>IiJ<l&Al'lON-ANl)- ' , - ----- ---.'- - - ~ - --- ~----- ..", _.on -- -"-------,. I. WC STATU-l 10TH- --
EMPLOYERS' LIABILITY , E.L EACH ACCIDENT 1$
ANY P.ROPRIETOR/PARTNERlEXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S
If~, describe under
S Ef'.W'- PROVlSIONR below E.L. DISEASE - POLICY LIMIT $
OTliER
B Professional Uabllity H70512823 0510212005 0510212006 500,000 per occurance
500.oo0aaareaate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ",~ 'o~" 12 ., ,,. c:
,.,'...., M!''-' ~.",
:;,},J HP.; ~ j-1M J;~:::L
Certificate Holder Is named as addltlonalinsured
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF T1iE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T1iE EXPIRATION
112 S. Osceola Avenue DATE T1iEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL .JL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Clearwater, FL 33758 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
A;roRlZED REPRESENTATIVE
. ,~, (V\ , ~
ACORD 25 (2001/08) , '"".- , @ACORDCORPORATION 1988